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Eastern Equine Encephalitis (EEE) in New Hampshire

Eastern Equine Encephalitis (EEE) in New Hampshire. Dianne Donovan, BSc Arboviral Surveillance Coordinator Ddonovan@dhhs.state.nh.us (603) 271-5927. EEE Transmission Cycle. Mosquito vector. Bird reservoir hosts. EEE History. 1831 – Horses in MA afflicted with an unknown encephalitis virus

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Eastern Equine Encephalitis (EEE) in New Hampshire

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  1. Eastern Equine Encephalitis (EEE)in New Hampshire Dianne Donovan, BSc Arboviral Surveillance Coordinator Ddonovan@dhhs.state.nh.us (603) 271-5927

  2. EEE Transmission Cycle Mosquito vector Bird reservoir hosts

  3. EEE History • 1831 – Horses in MA afflicted with an unknown encephalitis virus • 1933-1935 – Multiple equine outbreaks along the eastern seaboard • 1938 – 1st human case in NE reported. MA: 34 human cases, 248 equine • 1955-1959 – MA reported 16 human cases; NJ reported 33 human cases

  4. EEE

  5. NH Historical Perspective (EEE) • 1973 – 75 equine deaths; 12,000 pheasant deaths • 1978 – 28 equine deaths • 1980 – 1 human case reported (not confirmed), 1 equine death • 1982 – 1 equine death

  6. NH Historical Perspective (EEE) • 2004: EEE detected in horses, birds, and mosquitoes • 2005: Human cases - 7 reported human cases (2 died) - EEE detected in numerous non-human mammals, birds, and mosquitoes

  7. NH Historical Perspective (EEE) • 2006: EEE detected in horse, birds, and mosquitoes • 2007: 3 reported human cases - EEE detected in mosquitoes, a horse, an alpaca

  8. EEE Symptoms &Clinical Features

  9. EEE - Symptoms • Incubation 4-10 days • No symptoms in some people infected • Severe symptoms in others - short prodrome, ~5 days (fever, headache, abdominal distress) • Progresses to disorientation, seizures, muscle weakness, paralysis, coma, death

  10. EEE - Clinical Features • Common: F (83%), HA (75%), N/V (61%) < 50%: confusion, myalgia, abd pain < 10%: sore throat, diarrhea, CN palsies • Imaging (CT, MRI) abnormal in two-thirds of patients Source: Deresiewicz NEJM 1997

  11. Laboratory Findings(severe neurological disease) Peripheral Blood • Normal or elevated total leukocyte count • Lymphocytopenia • Anemia • Hyponatremia

  12. Laboratory Findings(severe neurological disease) Cerebrospinal Fluid • Pleocytosis (usually with a predominance of lymphoctyes) • Elevated protein • Normal glucose levels

  13. EEE - Diagnosis and Prognosis • Diagnosis by IgM serum/CSF • Confirmation by PRNT • Mortality rate 35% • Neurological sequelae in 30% of survivors • Lifetime expenses = $3 million/case

  14. EEE Treatment • There is NO specific treatment. • Care of patients centers around supportive treatment of symptoms and complications. • Vaccine – only available for horses.

  15. NH EEE PATIENTSDemographic & Clinical Characteristics

  16. Demographic & Clinical Characteristics Age: Mean = 40 years Range = 4-80 years Gender: 8 males; 2 females Onset Date: Earliest = August 3 Latest = October 1

  17. Demographic & Clinical Characteristics Prodromal Signs & Symptoms: Fever 9/10 Weakness 9/10 Fatigue 9/10 Headache 8/10 Myalgias 7/10 N/V 7/10

  18. Demographic & Clinical Characteristics Prodrome Duration (Days): Mean – 7 days Range - <1 to ~15 days SEIZURES: 4/10 COMA: 5/10 DEATHS: 2/10

  19. Suspect Case Reporting

  20. Criteria for Report (a, b, or c) • Any patient with viral encephalitis with - Fever > 100 F - CNS involvement - Abnormal CSF profile suggesting a viral etiology • Any patient with presumptive aseptic meningitis c. Guillain-Barre syndrome

  21. Criteria for Report • Severe arboviral disease has occurred in patients of all ages. • Consider patient travel history in off-season months. Year-round transmission is possible in some areas of the country.

  22. PREVENTION

  23. Personal Protection Works • Wear long sleeves and pants in light colors to minimize the opportunities for mosquitoes to bite. • Limit outside activity between evening and dawn when mosquitoes are most likely to bite. • Consider using an effective insect repellent.

  24. Insect Repellents

  25. Mosquito Repellents: CDC Recommendations • DEET - Used for >50 years, with millions of doses applied - Long-term safety established - In children: American Academy of Pediatrics affirms use of DEET (up to 30%) over 2 months of age

  26. Mosquito Repellents: CDC Recommendations • Picaridin - Used for years in Australia and Europe - Concentration available in US less - No serious toxicity reported • Oil of Lemon Eucalyptus - plant derived compound - No serious toxicity reported - Recommended for children >3 years

  27. The Bottom Line • Repellent adverse reactions, when used appropriately are extremely rare • EEE (and other mosquito-borne diseases) are definite, recognized threats to human health - Certain situations (risk factors for severe disease, outbreak situations) increase risk - Problems following arboviral neuroinvasive disease can be permanent

  28. Repellent Resources U.S. Environmental Protection Agency http://www.epa.gov/pesticides/health/mosquitoes/insectrp.htm National Pesticide Information Center http://npic.orst.edu/wnv/

  29. The 2008 Season?

  30. 2008 Season? • Unable to forecast the exact level of risk • NH communities with prior year’s EEE activity should consider mosquito-borne illness to be a human health risk for 2008

  31. Questions?

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